Treating pediatric depression: A shared responsibility

There are no simple solutions when it comes to pediatric depression or, worse, teen suicide. But faculty members at Lucile Packard Children’s Hospital Stanford are reaching out to local teens and schools in a community-wide effort to help those who may be struggling with mental health issues.

“We don’t want to lose any students. We are in the business of saving and improving lives,” said Shashank V. Joshi, MD, director of the Child & Adolescent Psychiatry Residency Program at the hospital and at Stanford Children’s Health.

Following the suicides of several teens in the Bay Area between 2009 and 2011, Joshi and his colleagues began working with local educators, primary care physicians, mental health professionals and community leaders in a series of teen mental health and suicide prevention initiatives. They developed resources for students who may suffer from depression and programs to reduce the stigma associated with mental health problems.

“Mental health is part of overall health, and therefore it is our business to make sure that it is part of our focus as doctors,” said Joshi, who is also associate professor of psychiatry and behavioral sciences and, by courtesy, of pediatrics.

Working closely with school officials and community partners, Joshi helped develop Project Safety Net, designed to assist youth and adults in recognizing and responding to teen mental health concerns. The comprehensive program includes training for teachers and staff at Palo Alto’s two high schools and the development of classroom curricula for social and emotional wellness among teens, staff and parents. Hundreds of student leaders at Bay Area schools have been trained as peer educators to spread a message of hope, help and strength among their classmates, Joshi said.

“Twenty percent of all youth will experience some kind of severe distress or depression by the time of graduation, and only 20 percent seek help. There is still a lot of stigma,” he said. “You cannot prevent suicide by training only adults; you also have to train the teens. Those in severe distress may not go to an adult, but they will often tell a peer.”

Shashank V. Joshi, MD

Additionally, Joshi and other mental health experts at Lucile Packard Children’s Hospital Stanford played a key role in helping form the HEARD Alliance (Health Care Alliance in Response to Adolescent Depression and related conditions), a consortium of Peninsula professionals committed to identifying and responding to teen depression.

“Among the main reasons teens say they don’t seek help is that they don’t want to disclose it to anyone. There is a perception the adults don’t understand, or they won’t care or know how to help,” Joshi said.

He said several factors, such as sleep problems, severe distress about school and extracurricular performance, relationships and life transitions, may make some teens more vulnerable than others. Suicidal thoughts may progress over a period of time, with recognizable warning signs. These include:

Hinting or talking about ways to die or attempt suicide

Feeling hopeless and/or having extreme sadness

Increased drug or alcohol use

Pulling back from friends and social activities

Severe mood swings

Increased agitation, anxiety, irritability and aggressiveness

Signs of self-harm, including cutting or burns

Local resources

EMQ FamiliesFirst Services, which can assess youth at home or school in Santa Clara County: 877-412-7474 / emqff.org